When the only woman in the room is you

This editorial refers to ‘How to plug the leaky pipeline in clinical rheumatology across Europe—lessons to be learned from experiences in business’, by Sautner et al., 2023;62:3538–46.

Over the holidays, a friend gave one of us a book titled ‘The Most Powerful Woman in the Room is You’ [1]. If we were to write a book about our time in academic medicine, the title would be ‘When the Only Woman is the Room is You’. The days of medicine when only men sat at the table in the room are still here. We have each been in many such rooms recently, usually as the only woman, not only in the United States but also in Europe. Oddly enough, we feel comfortable in such rooms, perhaps because it has been our reality for so long.

Barriers for advancement of women exist in many industries, so it is valid to look to business for models. The article ‘How to plug the leaky pipeline in clinical rheumatology across Europe—lessons to be learned from experiences in business’ in this issue by Sautner et al. describes the results of a survey developed by the authors and experts in economics to determine which factors motivated women to leave academic medicine [2]. The survey was sent to male and female rheumatologists in EULAR countries during the COVID-19 crisis. Women will soon be the majority of rheumatologists. However, women remain the minority in leadership positions and higher academic ranks, a fact reflected in the survey cohort.

The situation in Europe parallels that in the United States. The 2018–2019 Association of American Medical Colleges report showed that 29% of division directors are women. Although more women have entered academic medicine since 2009, the rate of academic promotion is unchanged [3]. Some issues identified as barriers to women in the Sautner study are different from those acting in the United States. For example, this study found that women did not cite ‘childcare responsibilities’ as an issue more often than men, perhaps due to Europeans having broad access to affordable childcare. Physicians in the United States experience higher burdens in childcare, specifically higher costs and less availability. As women continue to take the lead in childrearing duties, it is understandable that childcare insufficiency is a large contributor to women dropping out of the academic medicine pipeline [4].

Surprisingly, the study revealed that COVID-19 was not found to create a difference in the burden of childcare responsibilities between men and women in this European cohort. Perhaps the response in this survey is due to sampling bias, as many EULAR countries declined to send out the survey due to COVID. Selection bias could also be an issue, as those worst impacted by the COVID-19 pandemic would be less likely to respond. The difference may also be attributed to schools and day-care centres reopening earlier in Europe than in the United States. In the United States, 2.5 million women had left the workforce as at February 2021, which is felt to be largely due to the COVID-19 pandemic [5].

Europe may have mitigated the childcare burden on working mums by reopening schools and childcare earlier in the crisis [6]. In contrast, in New York City mothers led protests to reopen public schools closed due to concerns for spread of COVID-19 among students and teachers [7]. Personally, COVID-19 pushed one of us (B.K.J.) to the brink of quitting, with three young children and closed schools.

Notably absent in this survey was that mentorship was not identified as an issue by women more than men as a barrier for upward progression. The importance of mentorship for women to get into leadership positions has been widely reported to be critical. Having female support groups at work has also been shown to be effective [3, 8–10]. Could it be that the surveyed European countries have greater access to mentors for female physicians? If so, how are these countries accomplishing it?

For women to advance in academic rheumatology globally, we need not only to learn from each other but to look to similar models in diverse industries, including business. For example, corporate changes to create a more equitable work environment should be undertaken in hospitals. The most glaring deficit exposed by this study is that the lack of reliable and affordable childcare in the United States is making the playing field unfair to women.

To promote more women into leadership roles in rheumatology, we need mentors. Advocacy groups such as American Women in Rheumatology (AWIR) are a great source of both mentors and mentees. For those of us who have ascended the academic and leadership ladder, we need to help others follow us up the rungs. We need allies at the leadership level. We need men leading our profession to actively invest and champion the growth of women in leadership and academic positions.

Both of us are frequently asked, ‘How do you do all that you do?’ The answer is, ‘With a lot of help.’ If you do not want to be the only woman in the room, our advice is to invite more in.

Data availability

Data is owned by a third party.

Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

Disclosure statement: The authors have declared no conflicts of interest.

References